Comparison of the health care systems in Canada and the United States

Comparison of the health care systems in Canada and the United States are often made by government, public health and public policy analysts. The two countries had similar health care systems before Canada reformed its system in the 1960s and 1970s. The United States spends much more money on health care than Canada, on both a per-capita basis and as a percentage of GDP. In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714. The U.S. spent 15.3% of GDP on health care in that year; Canada spent 10.0%. In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on health care was 23% higher than Canadian government spending, and U.S. government expenditure on health care was just under 83% of total Canadian spending (public and private) though these statistics don’t take into account population differences.

Studies have come to different conclusions about the result of this disparity in spending. A 2007 review of all studies comparing health outcomes in Canada and the US in a Canadian peer-reviewed medical journal found that “health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.” Life expectancy is longer in Canada, and its infant mortality rate is lower than that of the U.S., but there is debate about the underlying causes of these differences. One commonly-cited comparison, the 2000 World Health Organization’s ratings of “overall health service performance”, which used a “composite measure of achievement in the level of health, the distribution of health, the level of responsiveness and fairness of financial contribution”, ranked Canada 30th and the U.S. 37th among 191 member nations. This study rated the US “responsiveness”, or quality of service for individuals receiving treatment, as 1st, compared with 7th for Canada. However, the average life expectancy for Canadians was 80.34 years compared with 78.6 years for residents of the U.S.

A 2004 study found that Canada had a slightly higher mortality rate for acute myocardial infarction (Heart Attack) because of the more conservative Canadian approach to revascularizing (opening) coronary arteries.

The WHO’s study methods were criticized by some analyses. Although there is a measure of consensus that life-expectancy and infant mortality mark the most reliable ways to compare nation-wide health care, a recent report by the Congressional Research Service carefully summarizes some recent data and notes the “difficult research issues” facing international comparisons.

The health care system in Canada is funded by a mix of public (70%) and private (30%) funding, with most end-services delivered by private providers.

Through all entities in its public-private system, the U.S. spends more per capita than any other nation in the world, but is the only wealthy industrialized country in the world that lacks some form of universal health care. In March 2010, the US Congress passed regulatory reform of the American health insurance system. However since this legislation is not fundamental health care reform, it is unclear what its effect will be and as the new legislation is implemented in stages, with the last provision in effect in 2018, it will be some years before any empirical evaluation of the full effects on the comparison could be determined.

Health care costs in both countries are rising faster than inflation. As both countries consider changes to their systems, there is debate over whether resources should be added to the public or private sector. Although Canadians and Americans have each looked to the other for ways to improve their respective health care systems, there exists a substantial amount of conflicting information regarding the relative merits of the two systems. In Canada, the United States is used as a model and/or as a warning against increasing private sector involvement in financing health care. In the U.S., meanwhile, Canada’s mostly monopsonistic health system is seen by different sides of the ideological spectrum as either a model to be followed or avoided.